As we face another new year with our resolutions recently made‎ - there is one more area to think about: the social determinants of health.

So what exactly is that? A new article in JAMA this week reminds us how where we work, live and play - the so called social determinants - are powerful factors impacting our health.

The article refers to social risk factors as toxic stress can affect vulnerable children. This is called epigenetics and refers to how environment can act as disruptors to physiological pathways and pathways in the brain- neuro cognition.

We have looked at studies such as the ACES study - adverse childhood experiences study and it showed how maltreatment in childhood impacts later health and wellbeing. This is called 'biological embedding of early experiences'

Despite knowing this, how often do we as doctors address social determinants of health?

The authors point out that childhood development is a process and social determinants are conditions but both are important to screen for.

So the question remains how to screen. Well the answer likely lies in your relationship with your physician and the ability of the physician to address them.

The authors suggest:

Identification of Social Determinants

  • elicit concerns
  • attend to parental concerns
  • have an ongoing social history
  • continue to look at parent-child interactions
  • consolidate through others
  • identify risk- ex- parental discord

Toxic Stress

  • maternal depression
  • parental substance abuse
  • child abuse/ neglect
  • unmet basic social need
  • food, housing, employment
  • smoking


  • Income
  • House
  • Education
  • Legal status
  • Literacy
  • Personal safety


  • Well child visit
  • Evaluation
  • Community Resources
  • Advocacy
  • Referral
  • Education

Every visit is an opportunity to screen. Ongoing screening and screening tools should be used, such as WE CARE, SEEK questionnaires.